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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493598
Report Date: 08/29/2023
Date Signed: 08/29/2023 10:25:29 AM


Document Has Been Signed on 08/29/2023 10:25 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:GRAY FAMILY CHILD CAREFACILITY NUMBER:
197493598
ADMINISTRATOR:AMBER & QUINCY GRAYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 200-4473
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:14CENSUS: 8DATE:
08/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Amber & Quincy Gray LicenseeTIME COMPLETED:
10:45 AM
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On 08/29/2023, Licensing Program Analyst (LPA) Adrian Risher conducted an Annual Inspection. LPA provided Licensee with the purpose of the visit and was granted access to the facility. LPA met with Amber Moore Gray, Licensee. LPA toured the inside and outside of the property with the Licensee. LPA observed the home to be clean, safe, orderly and well ventilated. There were 8 children present at the time of the inspection. The operating hours are Monday thru Friday 6:00am to 6:00pm with additional as needed.

LPA observed the home to have a Living Room, Kitchen, changing room, 2 bedrooms, and 2 bathrooms. The Licensee utilizes the living room, changing room and downstairs bathroom as the day-care. The rest of the home is inaccessible to the children. The living room is used for daily activities, eating and napping. LPA observed cots, mats and cribs that are used for napping. LPA observed age appropriate toys and equipment for the children.

Licensee states that there are no weapons in the home. Licensee reports that there are no pets in the home.

The kitchen and bathroom areas were inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects. These items were made inaccessible to children. Licensee has a lock box for medication. Cleaning supplies are stored in a locked cabinet in the kitchen. LPA observed electrical outlets with protective covers.

LPA observed operable smoke detectors and carbon monoxide detectors throughout the home which were tested during inspection. The home is equipped with 1 (2-A:10-B:C) Fire Extinguisher and First Aid kit which includes thermometer and band aids. Licensee has an A/C unit which is used to keep the home cool. Licensee uses a portable heater to keep the home warm during the winter.

LPA inspected the outside area and observed age appropriate toys. There are no bodies of water at the home. The outside play area is supervised by the licensee in the front yard.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRAY FAMILY CHILD CARE
FACILITY NUMBER: 197493598
VISIT DATE: 08/29/2023
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Licensee CPR card expires 02/2025. Staff and children's files were reviewed during inspection. LPA reviewed records related to earthquake drills and fire drills which were found to be current. All required Child Care Postings was observed on the Parent Board during inspection.

No deficiencies will be cited today

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.



Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRAY FAMILY CHILD CARE
FACILITY NUMBER: 197493598
VISIT DATE: 08/29/2023
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Amber Moore Gray
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3